A guide to pharmacological treatment for severe behavioural disturbance of adults in psychiatric in-patient settings in a regional area
Background: Acute behavioural disturbance is one of the commonest scenarios on acute psychiatric in-patients settings. The management of a disturbed behaviour depends upon the underlying cause. To de-escalate such a behaviour emergency treatment is required to prevent further risk to the person and others by maintaining a safe environment. This paper will guide a simple one page evidence based pharmacological treatment of short term management of acute disturbed or violent behaviour in an emergency setting. Method: The acute disturbed behaviour on in-patients settings could be due to various reasons in context of mental illness or disorder, personality disorder, substance misuse and physical illness. The Rapid Tranquillisation (RT) should only be used if other interventions like appropriate psychological interventions have failed to de-escalate violent behaviour. The aim of treatment should be treating the underlying cause of acute disturbed behaviour rather than over sedating patients, masking their symptoms which may result in delaying appropriate assessment and treatment. The commonest medication use to manage acute disturbed behaviour is one of the benzodiazines with or without antipsychotic medication and intense monitoring of physical observations after RT. Conclusion: To manage acute disturbed behaviour a comprehensive assessment and treatment by the experienced and trained multi disciplinary team is mandatory. The concise and precise one page guidance will assist the staff to manage patients with acute disturbed behaviour. RT is a treatment of last resort of acute violent behaviour rather than management of underlying condition.